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The Royal Commission into Aged Care Quality and Safety has recently released its Interim Report, giving some indication of how the Commission sees the challenges in our sector.

At the same time, we have had a very early start to the bushfire season in a number of states; this edition includes information on preparing for and managing the challenges of aged care during an Australian summer.

Given everything else happening in our sector, it was pleasing to have the opportunity to celebrate those who go above and beyond expectations at our 2019 ACIA Awards night.

While 2019 has been a big year, I can’t see 2020 being much slower, as we look towards the release of the Royal Commission’s Final Report, the pilot of the new residential aged care funding tool, and the ongoing need to provide care for older Australians.

The Royal Commission’s Interim Report – what does it tell us? AGE EDITOR | ISSUE 9

The Interim Report is presented in two volumes – the first provides an account of the evidence heard by the Royal Commission and of the views at which the Commission has arrived in response. This first volume indicates the likely thinking and future direction of the Commission. Volume Two contains case studies, fleshing out the broader narrative with more detail. Overall, the Interim Report finds that the aged care system needs reform – the Report specifically states that the problems identified are not caused by providers failing, but by system design. This reinforces the overall message that the system outcomes are driven by system design, which ACIA has advanced in our representations to Government. Report Overview The Report states that the history of the Commonwealth Government’s actions in Australia’s aged care system is a history of “piecemeal reform”. This position is reinforced by the Commission’s release of a background paper detailing 18 reviews of the aged care system in recent decades. Again, this suggests that the Commission will be looking to provide recommendations for systemic change, rather than individual behavioural change.

The report notes that “pay remains the most important issue” facing the aged care workforce, and finds that staff are “doing their best” in a challenging situation. The Report finds that the process of accessing aged care is poor – not only do individuals not plan for possible care needs in advance, but the My Aged Care system does not make access easy or smooth. One submission quoted by the Report characterises the impact of Commonwealth assessment processes on an older person with dementia as “institutionalised cruelty”.

The Report notes that waiting times for home care packages are significant, and publishes detailed data received from the Department of Health. These figures show that, for a Level 1 package, half of the people approved can expect to wait more than 7 months to receive a package; for a Level 4, this increases to half of people waiting more than 18 months.

In its treatment of restrictive practices, the Report quotes witnesses who suggest that prescription of antipsychotic medications in aged care exceed what would normally be expected. Witnesses are also quoted as stating that antipsychotics are effective in treating psychosis, but less effective in managing some other behavioural symptoms of dementia.

The Report also quotes witnesses stating that use of restrictive practices is, among other factors, due to lack of staff knowledge and skills. This leads into discussion of the aged care workforce – as the Commission notes, the workforce is central to aged care.

Attracting and retaining individuals with the right skills and personality is a challenge – and the scope of this will only increase over time. Finally, the Report addresses the challenges of younger people with disabilities in aged care, noting that, for many younger people, residential aged care is a challenging place to be. Future directions While it is important to remember that this is the Interim Report – the Final Report may differ in its views or emphasis – some preliminary indications can still be gleaned.

Most fundamentally, the Commission is clearly of the view that systemic reform is needed; small adjustments here and there will not be sufficient to meet community expectations. 1. The report indicates that the Commission will express a view on the suitability of market-based policy thinking. The report leaves it open whether the Commission will challenge the use of marketbased approaches as the basis for aged services provision.

future of the aged care system. The report repeatedly states that older people prefer to remain in their own homes (while also noting that, historically, the Commonwealth has believed home care to be a cheaper means of support than residential care). With published information on waiting lists laying bare the mismatch between demand and funding, it is probable that this will remain a policy focus in the medium term.

3. The Commission places weight on publication of data as an element in addressing shortfalls. It is likely that this will lead to more requirements for data collection and publication – existing Government policy is tending in this direction already, such as the collection of the new Clinical Quality Indicators. 4. The Commission has identified challenges and shortcomings in the education and training systems that produce the aged care workforce. Improved staff skills and knowledge are suggested a number of times as an element in responding to challenges in the aged care system.

5. It is troubling that the Report airs claims of regulatory capture – “some observers suggest… that regulatory action serves the interests of providers”. Taken in concert with the findings of the Hayne Royal Commission that financial regulators were “captured” by the institutions they regulated, this suggests that the Commission’s thinking may lead to recommendations to strengthen regulators’ powers, and to increase separation between regulators and industry. This may not support constructive engagement between industry and regulators in a continuous improvement environment. Overall, the Interim Report paints a picture of a system in which the best efforts of individuals often struggle against system design. If the Commission can recommend systemic reforms that support the needs of Australia’s older population now and into the future, we will all be the better for it.

Luke Westenberg ACIA CEO